8065 SW THORN STREET ADDRESS:
Orucords\microfIm\targets\bullding.doc
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I.(i&-PECTION NOT-L—
City of Tigard Building Department
13125 SW Dell Blvd. Tigard, Oregon 97223
Inspection Line (Roc--O-Phone)t 639-4175 Business Phone: 639-4171
Inspactiont_
Footing Pltg. Underslab Hoch. Rough-in Appr/Sdwlk
Fouad. Plbg. Top rut Gas Line FINALt
Post/Beam Struct. San. Sewer Frening -Bldg.
Pont/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Liner Gyp. Bd. -Hoch.
Data Requested: `� L `/ _-Timet �y1AN PH
Addreaat !S SJ �./ /�-� 1/VL/ Permit /tel!//
Bu i-lder t
THE FOLLOWING CORRE'.:.ON;; ADE REQUIRED:
Inspector, �� _---.---—�— Date s _
� APpAdV=0 DISAPPROVED APPROVED SUBJECT 77 ABi7Vt
Call For Reinsp.
CITY OF TIGARD
COdMUNir( DEVELOPMENT DEPARTMENT
13126 SW Hall Slvd.Tigard,Oregon .17223o8199 (503)639-4171 dLUMBING PIL"Rf`
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COPY TO:
APPLICATION - STREET IMPROVEMENT/EXCAVATION IM (WHITE)-FILE
INSP-
ORDINANCE NO. 74-14 (YELLOW)•
// --�'�® (PINK)-OTHERER
ARENCYbid9,
(INSTRUCTIONS ON SEPARATE SHEET) P7 ® (BLUE)-APPLICANT
APPLICATION NO.:
APPROV ED ® 32.W
NOT APPROVED [] CITYOF TLGARD, OREGON FEL AMT.: s_— --
CITY HALL. RECEIPIT p.: g3'��op0
PENDING FEE. PMT. ❑
PENDING SECURiTY [.] PU3LICWORKS DEPARTMF_NT F3-G — — DATE — — —
- - - -
PENDING AGENCY ''OK'' ❑ Application and Progress Record MAINTENANCE BOND it
FOR STREET IMPRDVEMENT/EXCAVATiON AS REQUIRED
PENDING; INFORMATION ❑ ANNUIII-
PENDING VARIANCE EXP. 'ATI N DATE:
�,� S DATE ISSUED: BY:
PERMIT NO :
ItE'r�AIR `R REPL -C' BLDG, SIDE_.-
(1) APPLICATION IS HEREBY MADE TO EXCAVATE FOR AND WMAILL -- - - -
SAdT�iAEi3Ca. AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
S1045 SW Burnham St. Tigard, OR 97223 639-3701
APPLICANT _ Mndrarn Plumbing %ooREss c1T�— rHONfi
NAME
(Sam)CONTRACTOR _. — clTr -fHo'Ne___
NAMCT_ ADDRESS -
- per City Standards & 3Pec.ificatic"' - —
HONE
PLANS BY --"—` ADDRESS CI
NAME
800❑❑vy1� �ry�-�
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST)' .W
DOLLARS
-
__�___,_.
_-._--_.. FOR OFFICE USE'
(2) EXCAVATION DATA: _ o.04 X s f--- � -
DESCRIPTION PROGRESS & INSPECTION STATUS
STREET ITEM DATE REMARKS/TYPE BY
NAME SURFACE CUT CUT CUT MATERIAL STALLED
TYPE LENGTH WIDTH DEPTH ITEM B QUANTITY STREET
--'�r��- INSPEC•
lborn Stre t (see ElttliCll R TION
E
Q
U -
E
ESTIMATED STREET OPENING DATE: 1- - T ---
ESTIMATED STREET CLOSING DATE: I -1- ED -
- .� .-- -'
OO
STREET
LSED
(3) SECURITY NO -- SECURITY AMT S _800' —
- FINAL.
SURETY CO.: N
.
- --
Cp �- ----
HECK �[ CASH CI
BOND
�". I
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL
SPECIAL ROVISIONS CONDITIONS
FEATURES; EXCAVATION LOCATION AND EXTENT. _ ---
'
SITE: 8065 S.W. Thorn StrjNlt (see attached)
I work area
xx
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X10.
(S) _ NOTE THE CITY OF TIGARD DOES NOT, HEREBY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK
WHERE
RIGHT-OF-WAY JURISDICTION IS THAT OF WASHINGTON COUNTY OR THE STATE OF OREGON
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, 'f0 COMPLY WITH ALL PERTINENT LAWS ANC
CONSTRUCTION SPECIFICATIONS PERTINENT .O CONDUCT OF THE WORK, AND TO SAVE HARMLESS THE CITY ANr
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS
L_' /i DATE
APPLICANTS SIGNATURE .d